In the eighteenth century, “madness” was used as a catch-all description for just about any type of mental illness, from depression to full-blown psychosis and mania. The causes were much debated, not just by medical men either. Some saw madness as a physical problem (an imbalance of the humours), others as a psychological problem (a response to grief or stress), a moral problem (a breakdown in behaviour caused by licentious excess, drink or drugs), or even a spiritual one (brought on by excessive religious zeal or occasioned by demonic possession).

Depressive or Genius?

Depression, or melancholia, was especially common amongst the better educated. Indeed, foreigners sometimes referred to it as ’The English Disease’. Yet, following Aristotle, it could also be viewed as conferring a mark of special genius or imaginative power.

The name comes from the idea that it was caused by an excess of black bile in the body. In the Aristotelian view, such an excess produced a tendency towards suspicion and fear of others, coupled with a general darkness of outlook and misanthropic view of the world. Yet melancholics were also credited with strong intellectual powers, acute perception, a powerful critical faculty and great expressiveness in communication. Indeed, you could hardly be accepted as a great artist or poet unless you were also somewhat melancholic in your personality.

Could Madness be Cured?

Everyone weighed into the debate, from professional medical men through ‘empirics’ (non-qualified practitioners) to clergymen like John Wesley, the founder of Methodism. They disagreed over treatments and causes and whether madness should be seen as an incurable descent into irrationality, or an understandable, and curable, response to some overwhelming stimulus or life event. Did madness somehow reduce you to an animal-like state or was it a disease like any other?

Certainly few, if any, of the treatments available for most of the century were likely to do much good, save via a placebo effect. It is also clear that those judged mad amongst the lower classes were much more likely to be incarcerated than their social superiors. At the same time, private asylums could be notably profitable businesses. What went on in them varied from the luxurious to the horrific. Still, the fact that enough people were prepared to pay highly to make certain ‘mad-doctors’ rich shows how common mental illnesses were amongst the better-off. It is also true that it took little effort to have a troublesome or unwanted family member confined for life under the guise of being mad — so long as you could pay the fees demanded. The romantic novel’s stereotype of the mad wife in the attic was not always very far from the truth.

Much has been written on the evils and cruelty of certain eighteenth and nineteenth-century practices in madhouses and asylums, but the reality was, I believe, far more complex, with every kind of response from vicious disdain to empathy and genuine kindness. It’s a vast topic, and one I intend to return to more than once. However, to start on a lighter note, here’s a list of supposed causes of madness amongst those confined in London’s Bedlam Hospital in 1810[1]. The numbers indicate the number judged to have been driven mad by each item:

Causes of Madness

It is clear that, in the eighteenth century, mental illness was most usually seen as essentially similar to physical illness, at least to the extent that both could be traced to an actual event or a tangible bodily dysfunction. The table below shows that clearly. There are no mentions of invisible psychological factors, such as neuroses. Their time had yet to come. The only inner, intangible causes listed are emotions such as pride, jealousy, fear or love.

What this seems to reflect is a view that madness is as madness does. Diagnosis was based on observable behaviour. A person was judged mad if he or she acted in ways commonly held to indicate insanity. Madness was not, in itself, unnatural, let alone culpable. Thus the mad person was only in need of custodial treatment if his or her behaviour became socially outrageous or was otherwise unacceptable. The ‘village idiot’ might be taunted and mocked, but no one thought he or she should be locked away. Rich eccentrics often flourished and were typically viewed with a good degree of indulgence.

Cause	Number of Cases
Misfortunes, troubles, disappointments, grief	206
Religion and Methodism	90
Love	74
Jealousy	9
Pride	8
Study	15
Fright	51
Drink and intoxication	58
Fevers	110
Childbed	79
Obstruction	10
Family and heredity	115
Contusions and fractures of the skull	12
Venereal	14
Smallpox	7
Ulcers and scabs dried up	5

I love the idea that someone thought more people had been driven mad by Religion and Methodism than by drink, venereal disease and head injuries put together! Childbed presumably refers to what we would term post-natal depression, still sadly common today. It’s interesting too that Heredity was seen as producing only half the number of cases of insanity as Misfortunes and griefs. Doesn’t that argue for a refreshing doubt about the commonplace notion that mental illness is usually congenital?

Fright makes some kind of sense, I suppose, at least if it refers to overwhelming and irrational phobias. But what about Love being apparently some seven times more likely to drive you insane than Jealousy? How would fevers make your sanity collapse? And what on earth was meant by Obstruction? People driven mad by constant constipation?

Much food for thought here — so long as the Study doesn’t drive you over the edge!